Provider Demographics
NPI:1750309738
Name:MILES, JAMIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:A
Last Name:MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:ALLISON
Other - Last Name:MILES-YANAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3400 COLVILLE PL
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4140
Mailing Address - Country:US
Mailing Address - Phone:818-461-9294
Mailing Address - Fax:
Practice Address - Street 1:5601 DE SOTO AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6701
Practice Address - Country:US
Practice Address - Phone:818-719-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G792410Medicaid
G79241Medicare ID - Type UnspecifiedPPIN
CA00G792410Medicaid